States Where Persons Infected with the Outbreak Strain of E. coli O157:H7 Live, United States, by State, March 1, 2009 to July 31, 2009

Infections with the Outbreak Strain of E. coli O157:H7 By Date of Report to PulseNet

CDC is collaborating with public health officials in many states, the United States Food and Drug Administration (FDA), and the United States Department of Agriculture Food Safety and Inspection Service (FSIS) to investigate an outbreak of E. coli O157:H7 infections.

Most persons became ill during May and June. Ill persons range in age from 2 to 65 years; however, 66% are less than 19 years old; 69% are female. Thirty-five persons have been hospitalized, 10 developed hemolytic uremic syndrome (HUS); none have died.

Investigation of the Outbreak

In an epidemiologic study, ill persons answered questions about foods consumed during the days before becoming ill and investigators compared their responses to those of persons of similar age and gender previously reported to State Health Departments with other illnesses. Preliminary results of this investigation indicate a strong association with eating raw prepackaged cookie dough. Most patients reported eating refrigerated prepackaged Nestle Toll House cookie dough products raw.

On June 29, 2009, the U.S. Food and Drug Administration announced that a culture of a sample of prepackaged Nestle Toll House refrigerated cookie dough currently under recall yielded E. coli O157:H7. The contaminated sample was collected at the firm on June 25, 2009. Further laboratory testing showed that the strain in the sample was not the outbreak strain.

E. coli O157:H7 has not been previously associated with eating raw cookie dough. CDC, the state health departments, and federal regulatory partners are working together in this ongoing investigation.

Clinical Features

Most people infected with E. coli O157:H7 develop diarrhea (often bloody) and abdominal cramps 2-8 days (average of 3-4 days) after swallowing the organism, but some illnesses last longer and are more severe. Infection is usually diagnosed by culture of a stool sample. Most people recover within a week, but some develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; this can occur in people of any age but is most common in children under 5 years old and the elderly.

Advice to Consumers

The Food and Drug Administration and the Centers for Disease Control and Prevention continue to warn consumers not to eat any varieties of the recalled Nestle Toll House refrigerated cookie dough due to the risk of contamination with E. coli O157:H7. This includes Nestlé Toll House cookie dough that does not say "new batch" on the labeling. Consumers who have the recalled prepackaged, refrigerated Nestle Toll House cookie dough products in their homes should throw it away. Cooking the dough is not recommended because consumers might get the bacteria on their hands or on surfaces. The recall does not include Nestle Toll House morsels, which are used as an ingredient in many home-made baked goods and other baked cookie products. The recall also does not include newly made Nestle refrigerated cookie dough products; these products can be identified by labels with shields that say “new batch” on them.

Individuals who have recently eaten recalled prepackaged, refrigerated Toll House cookie dough and have experienced any of these symptoms should contact their doctor or health care provider immediately. Any such illnesses should be reported to state or local public health authorities.

Consumers should be reminded they should not eat raw food products that are intended for cooking or baking before consumption. Consumers should use safe food-handling practices when preparing such products, including following package directions for cooking at proper temperatures; washing hands, surfaces, and utensils after contact with these types of products; avoiding cross contamination; and refrigerating products properly.

Advice to Retailers, Restaurateurs, and Food-service Operators

Retailers, restaurateurs, and personnel at other food-service operations should not sell or serve any Nestle Toll House prepackaged, refrigerated cookie dough products subject to the recall.

Previous Updates

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